Citizens for Bringing Back Our Share I
F 4 e.~ uili
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
1. DATE OF REPORT 72.. NAME OF COMMITTEE
oupc
"d evq 4-u
2. SHORT NAME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
t d e iteie d, o a s L),//e TAI. _3_7777 4. MEASURES SUPPORTED OR OPPOSED
5.A. NAME OF POLITICAL TREASURER 5.B. DATEAPPOINTED
6. FIRST ORY OR REPORT RT (Chec TMe~ FOURTH ❑ - 1:PRE- 1 MID❑YEAR YEAREND
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A. BEGINNING DATE OF REPORTING PERIOD 7.B. ENDING DATE OF REPORTING PERIOD
Ll-27_/ -2-/
8. (Check one)
A. ❑ This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. I do solemnly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1 Of must also be completed.)
B. ® This committee is required to file a detailed financial disclosure because contributions (including in-kind) received total more than
$1,000 and/or expenditures total more than $1,000 for this reporting period. I do solemnly swear or affirm that the information con-
tained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expendi-
tures requried to be reported by political campaign committees by the Campaign Financial Disclosure Act.
` t, OFD t~t , _ 2 - /
gnature of political treasurer date
9. WITNESS SIGNATURE -
6 -?_(Y
signature of witness date
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $ L' -79
Sp, e) 6
b. TOTAL RECEIPTS THIS PERIOD
c. TOTAL DISBURSEMENTS THIS PERIOD $ 22,
d. BALANCE ON HAND 10.a. plus 10.b. minus 10.c.
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1140 (Rev. 2/06) RDA 1159
SC
11. NAME OF COMMITTEE (In Full) UMMARY PAGE - SM
12. REPORT COVERING THE PERIOD
f o,e ~ , RECEIPTS /40V cY V a
/15 S/.q FROM: q-Z7 T0:
13. CONTRIBUTIONS (other than loans and interest)
a. Unilemized Contributions ($100 or less from each source this period)
b. Itemized Contributions over 100 from each source this period) $ sv" 0cJ
C. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ O
14. LOANS RECEIVED THIS REPORTING PERIOD $ 0 i
15. INTEREST RECEIVED THIS REPORTING PERIOD............ $
16. TOTAL RECEIPTS (add 13.c., 14.,
and 15.) (must be shown in item 10.b.
DISBURSEMENTS ) ~o. ev
17. EXPENDITURES (other than loan payments)
a. Unilemized Expenditures
gasoline) ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
Y S
0u,.~t $ 31, uu
Total of Expenditures ($100 or less each payee) $ a -7
b. Itemized Expenditures (Over $100 each payee this period) $ _ 1 • 73
c. TOTAL EXPENDITURES (other than loan repayments)(add 17.a. and 17.b..)
18. LOAN REPAYMENTS MADE THIS PERIOD $ 32 7
19. TOTAL DISBURSEMENTS (add 17.c. and 18.) (must be shown in item 10.c.) $ 0
20.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period).......... $ d
b. Itemized in-kind contributions (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $ U
21.LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22.OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $ 0
b. Itemized Obligations Outstanding (Over $100 each) $ 0
C. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.)
k SS-1145 (Rev. 4102)
RDA 1159 Page of
1. NAME OF ITEMIZED STATEMENT OF EXPENDITURES - SMC
COMMITTEE
l n!S /=0 2. REPORT COVERING THE PERIOD
nJ u S J42 CL FROM:
Y- .2 7 T0: 51 Z
3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) Amount
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (any expenditures totaling more than $100 to a sigle payee during the period,
must be itemized.)
First Name
Middle Name
Purpose of Expenditure
Last Name/Business Name Amount of Expenditure
/ Z/?
Address l L i Y U' J ®7~ fOp ~L 5 `CJ z
.e ve .
city
~R U State Zip Code
1-c irk,
First Name
Middle Name Purpose of Expenditure
Last Name/Business Name Amount of Expenditure
3 0~W t ~ f; ,J rv
Address
v l ~ S l 2 (7 2 . C' ~ os.-e v u. t f~ cc~ ~ ti's
city
~n
arz v l Ile State Zip Code
3-7 ~?U
First Name
Middle Name Purpose of Expenditure
Last Name/Business Name Amount of Expenditure
Address
city State Zip Code
First Name
Middle Name
Purpose of Expenditure
Amount of Expenditure
Last Name/Business Name
Address
city State Zip Code
rrst ame
le ame urpose o xpen nure
cunt o Expenditure
Last Name/Business Name
Address
City State Zip Code
First Name Middle Name
Purpose of Expenditure Amount of Expenditure
Last Name usiness Name
Address
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.)
If this is the last a e of ram ai n ex enditures this amount must be shown in item 17b. of summary. L f 3Z . 7
c3j
am: SS-1142 (Rev. 4/02)
Page of RDA 1159
ITEMIZED STATEMENT OF LOANS - SMC
1. NAME OF COMMITTEE
2. REPORT COVERING THE PERIOD
FROM: T0:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Loans Loan Payments Outstanding Balance
LOAN (loans totaling more than $100 owed to any person/business at the end of (Be innin
the reporting period) 9 9 Received This (End
First Name of Period) This Period Period of Period)
Middle Name
L Wurnelbuslness Name
Address
city state Zip Code Date of an
First Name Middle Name
Last Name/Business Name
Address
ity State Zip Code
Date of Loan
EFWName Middle Name
usiness Name
ress
city State LpCode Date of Loan
First Name Middle Name
LastNameBusiness Name
Address
City State Zip Code
Date of Loan
First Name Middle Name
Last NameBusiness Name
Address
City State Zip Code
Date of Loan
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in Item 21 on summa a e.
i„t SS-1146 (Rev. 4/02)
Page of RDA 1159
- _ I
ITEMIZED STATEMENT OF CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
/ v FROM: T0:
Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor Burin the period
First Name M.I. Last Name/Organizabon Name Amount of Contribution
Address
city State Zip Code
Occupation
Employer
First Name M.I. Last Name/Organization Name Amount of Corrtdbubon
Address
city State ZpCode
Occupation
Enployer
First Name M.I. Last Name/Organization Name Amount of ConbiWtion
Address
City Slate Zip Code
Occupation
Employer
First Name M.I. Last Name/OrganizationName Amount of Contribution
Address
City State Zip Code
Occupation
Employer
First Name M.I. Last Name/Organization Name Amount of contribution
Address
city State Zip Code
Occupation
Employer
5.TOTAL ITEMIZED CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this is the last page of contributions, this amount must be shown in item 13b. of summary.)
SS-1141 (Rev. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE / 2. REPORT COVERING PERIOD
" FROM: TO:
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period)
First Name Middle Name Description of In-IGnd Contribution Value of In-Kind Contribution
Last Name/Organization Name
Address
City State Zip Code
Occupation
Employer
First Name Middle Name Description of In-Knd Contribution Value of In-Kind Contribution
Last Name/Organization Name
Address
City state Zip Code
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of IMGnd Contribution
Last Name/Organization Name
Address
City State Zp Code
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of IrAnd Contribution
Last Name/Organization Name
Address
City State Zip Code
Occupation
Employer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3 of next page if additional pges of this form are used.)
(If this is the last page of in-kind contributions, this amount must be shown in item 20.b. of summary.)
SS-1143 (Rev. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF OBLIGATIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
NIfi- FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any person/vendor at (Beginning Incurred This (End
the end of the reporting period) of Period) This Period Period of Period)
First Name Middle Name
Last Name/Business Name
Address
City Stale Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City Stale Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
CRY State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
4. TOTALS
(Total from 'Outstanding Balance - (End of Period)" column must also be shown
in item 22.b on summa a e.
ti, SS-1144 (Rev. 04102) Page of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
1. DATE OF REPORT 2. NAME OF COMMITTEE
_ C)LL /z Sl~.rlf~
L j C( 12eit/~ ~'~t)2 C3~iN~' nl 8,q r-
2. SHORT NAME OF COMMITTEE (IFAPPLICABLE)
Yl
3. ADDRESS AND PHONE
Street or Rural Royte City [ ej c A iS u'l L L *-State Zip Code Phone
Z Z o l2 ' t A to r2 ►~d,_~r1~,. i 2 -7 -7 7
4. MEASURES SUPPORTED OR OPPOSED
SA rL- 7pi ca e r25 le-
5.A. NAME OF POLITICAL TREASURER r 5.8. DATEAPPOINTED
-A rA 3 -7
6. CATEGORY OR :REPORT (Check 1 one) ❑ ❑ O ❑
FIRST SECOND THIRD FOURTH PRE PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A. BEGINNING DATE OF REPORTING PERIOD 7.B. ENDING DATE OF REPORTING PERIOD
8. (Check one)
A. ❑ This committee is exempt from detailed disclosures because contributions (including in4dnd) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. I do solemnly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1 Of must also be completed.)
B. IM This committee is required to file a detailed financial disclosure because contributions (including in-kind) received total more than
$1,000 and/or expenditures total more than $1,000 for this reporting period. I do solemnly swear or affirm that the information con-
tained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expendi-
tures requried to be reported by political campaign committees by the Campaign Financial Disclosure Act.
signature of political treasurer date
9. WITNESS SIGNATURE
signature of witness date
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
t) ~ . Ott
b. TOTALRECEIPTSTHISPERIOD $ Z'J
c. TOTALDISBURSEMENTSTHIS PERIOD $ Z ~l 7 ` L 7
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ 3 '9~ 2 , 73
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $ (J
SS-1140 (Rev. 2/06) RDA 1159
i
SUMMARY PAGE - SMC
11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD
f A(t e--
l f l z 2A/ S /-p i2 13oi>v r'w 3 A c R o viz FROM: T0: " 2lv
RECEIPTS
13. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ //o OO • O U
b. Itemized Contributions over $100 from each source this period) C p , t1
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ 2-660.
14. LOANS RECEIVED THIS REPORTING PERIOD 6
15. INTEREST RECEIVED THIS REPORTING PERIOD 6
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $ Z S:.) v
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline) ,
FP- rv$371.`5
$
$
$
Total of Expenditures ($100 or less each payee) $ d
b. Itemized Expenditures (Over $100 each payee this period) $ Z l / 7 - 27
c. TOTAL EXPENDITURES other than loan re a ents add 17.a. and 17.b.. $ 2 / i 7 .2-7
( P Ym )
18. LOAN REPAYMENTS MADE THIS PERIOD $ U
19. TOTAL DISBURSEMENTS (add 17.c. and 16.) (must be shown in item 10.c.) $
Z / Z
20.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period).......... $ U
b. Itemized in-kind contributions (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $
U
21.LOANS
LOANS OUTSTANDING (must be shown in item 10.e.) L~
22.013LIGATIONS
a. Unitemized Obligations Outstanding ($10D or less each) $ D
b. Itemized Obligations Outstanding Over $100 each
C. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 101) $
SS-1145 (Rev. 4/02) RDA 1159 Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
C t~ 2eN~ Fat 911-Q OJ2 S ri FROMG I TO:1-1ZG-/
Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) ?W, 0a
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor Burin the period
First Na M.I. Last Name/Organization Name Amount of Contribution
Address
a 2 L Oc`,Sv' lIG 01p~ti rx l
city State Zip Code
a"w fie-
Occupation ,
(V
Employer
~~N~ 1~w~a fin fcJ;Fn1
First Name M.I. Last Name(0 anizalion Name Amount of Contribution
Add
(xj
City State Zip Code 5 "
M I,
Occup 'o
Employer
)U f v~ ,w6
First Name M.I. Last Name/Organization Name Amount of Contribution
Address
City State Zlp Code
Occupation
Employer
First Name M.I. 7st Name/Organization Name Amount of Contribution
Address
City State Zip Code
Occupation
Employer
First Name M.I. Last Name/Organization Name Amount of Contribution
Address
City State Zip Code
Occupation
Employer
530TAL ITEMIZED CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this is the last page of contributions, this amount must be shown in item 13b. of summary.)
W SS-1141 (Rev. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
-2
i L vJ c O G~ R S A r2 FROM: _ F
cum / c >dL tn/ C/r< nt
. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
3
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (any e)penclihres 9 more than $100 to a sigle payee during to period,
must be itemized.)
fr6ddle Name Purpose of Expendllure Arrorml of Expenditure
FrslName
test wamaleusiness Name s. 1st t f ~t t P"') ! fv, f r" L `/t` r? S 371 irx) Address
28 03 /V16 i2 f o tit 2d .
_
shft
ap Code
/'✓1J f2 tl e- iw .
Mkkle Name Purpose of ExpmdiWm Amami of Egperdf ure
Fkst Name
Last Narrieftabep Name
I rj Lw r l j t S :z 4 S
Address
City Sp Code
x412 t/ t l 1~ ! rv~ o f
First Name WKkle Name Purpose of Exper-i Mrourd of Expenditure
Last Nam Business Name i L M A i 4 A:- (Jr l~ D
f' X A; S r'v c e tNI ,e-
Address i rr4 o -r rr
O 5";N 'f'tcw c1.
City state Zip code
Me -I;v+ 37 77
Amorad of Egture
Feat Name Middle Name Purpose of Epgpenddrae
Lest Namousinm Nam
Address
CAY state Zip code
oral arm Wdle ame
Last NanrelSuskiess Nana
Address
City stale Zip Code
Nrarmt of Ex pwoAn
Fasl Name Mkkle Name Purpose of F->
Last Name
Address
City T"- I Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to Item 3. of next page if additional pages of this form are used.) 2 1
ff this is the last page of campaian expenditures, this amount must be shown in item 17b. of summary.)
SS-1142 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING PERIOD
FROM: TO:
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter 0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (v~-wnd wntrrbutions toteting more often $100 from any conWitor during the period)
FW Name Viddle Nance Desaiptlm of in4QW Contnbution value of Irrlond Contribution
Last Name/Organha ion Name
Address
city Slate Zip Code
o=vatbn
EffqAq-
FrstName WddleName Desaipbm of irr" Carriabutim Valueofkr*W Ca*bjbon
Last Narne0gatbsim Name
Address
CRY Stale ZpCode
Occupation
Employer
First Nance b4ddle Name Description of Natid Car*brrbon Valueof ku Krud Cmtribution
Last NamelOrgave6m Name
Address
city stab Zrpcode
ERplOyer
First Name Wddle Name Desaip6m of WW UnUbufion Vefue of"nd Contribution
Last NenuelOrgangaian Name
Address
CRY shoe ZpCode
Ocu"Wn
Empoyer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3 of ne)d page N additional pges of this form are used.)
(If this is the last page d irkind contributions, this amount must be shown in item 20.b. of summary.)
AWL
SS-1143(Rev.2106) Page o(__ RDA1159
ITEMIZED STATEMENT OF LOANS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
IVI A FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Loans Loan Payments Outstanding Balance
(Period)
LOAN poans totaling more than $100 owed to any person/business at the end of (Beginning This Pevew This Period of (Period)
the reporting period) of Period)
Red Name hurdle Name
Lad Nanelausiress Name
Ad*m
CRY State 2ipCode Date of Loan
Fist Nane 6iddle Name
LastNameMusiressName
Address
City State c7- ode Date of Loan
Fier Nam Wile Name
L"NanvausiemNare
Address
qH SUB DpCode Date of Loan
Rd Name piddle Name
LaANan dkNhe%Nane
Address
City 81* Code Date of Loan
Fist Name Mile Name
LadNemeSusirw Hone
Address
CRY State ZIPCode Date of Loan
4. TOTALS
(Total from 'Outstanding Balance - (End of Period)' column must also be shown
in Rem 21 on summary
w.il: RDA 1159
O SS-1146 (Rev. 4/02) Page of
1
ITEMIZED STATEMENT OF OBLIGATIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
I VA FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any person/vendor at (Beginning Incurred Ttus (End
the end of the repor ft period) of Period) This Period Period of Period)
First Name Midde Name
Last NamwBusiness Name
Address
Cdy We Zp Code
Desaip wofObigaWn
First Middle Name
Last NarrWBustrress Name
Address
CHy State Zp Code
lest Name Middle Name
Last NarnagusaiessName
Address
at/ State ZQ Code
DesaioianofOhRpa6an
Fast Name Midde Name
Lasl NwwfB skms Name
Address
Cigr State ZIP Code
Desaiq-ofObig>I -
First Name Middle Name
Lest NamelBusiness Name
Address
CRY scale Zip Code
Desaip wofMgaban
4. TOTALS
(Total from'Outslanding Balance - (End of Period)' column must also be shown
in item 22.b on summary, pw.)
w SS 1144 (Rev. 04102) Page of RDA 1159
•5~r
APPOINTMENT OF POLITICAL TREASURER
For Single-Measure Committees
INSTRUCTIONS
This form must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. §2-10-105)
for single-measure committees. No funds may be received or expended for a future election until a political treasurer has been
appointed. A new form must be filed if the treasurer is changed.
Single-Measure Committees supporting or opposing statewide referendums must file an original of this form with the Registry of
Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Single-Measure Committeess supporting
or opposing local referendums must file an original of this form with the local county election commission in the county where the
election is to be held.
1. Date 2. Name of Committee
April 3, 2014 Citizens For Bringing Back Our Share
3. Address and Phone Street or Rural Route City State Zip Code Phone
4220 Ridge Water Road, Louisville, TN 37777 (865) 681-9372
5. Election Date
4. Measure Supported or Opposed 2014
Increasing Local Option Sales Tax May 6,
6. Treasurer Name
Jim Hinkle
7. Treasurer Address and Phone Street or Rural Route City State Zip Code Phone
4220 Ridge Water Road, Louisville, TN 37777 (865) 681-9372
8. Appointing Authority and Treasurer Signature (Both signatures must be witnessed. Treasurer can not witness signature.)
Signatu ~fTrasurer
ignature of A ointing Authority
Signature of Witness Signature of Witness
<; Q
RECEIVED
i
APR 04 1014
ELEA. V1,
ll 01 b
Registry of Election Finance RDA Pending
SS-1107 (Rev. 8/04)